ECMO在中毒中的应用

新用户60976047 2022-09-19 发布于云南

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转自南通大学附属医院急诊医学科

研究目的

评估美国使用体外膜氧合治疗中毒的趋势。

To assess trends in the use of extracorporeal membrane oxygenation for poisoning in the United States.

研究设计

回顾性队列研究。

Retrospective cohort study.

单位：

国家中毒数据系统（National Poison Data System），该数据库由美国中毒控制中心协会（American Association Of Poison Control Center）拥有和管理，2000-2018年间该组织支持和认证全美55个毒物中心。

Setting:

The National Poison Data System, the databased owned and managed by the American Association of Poison Control Centers, the organization that supports and accredits all 55 U.S. Poison Centers, 2000–2018.

患者：

所有向国家毒中毒数据系统报告的使用ECMO治疗的患者。

Patients:

All patients reported to National Poison Data System treated with extracorporeal membrane oxygenation.

干预：

无。

Interventions:

None.

研究结果

总共有407名患者符合最终纳入标准（332名成人，75名儿童）。中位年龄为27岁（四分位间距，15–39）；52.5%为男性。摄入物质的中位数是3（四分位间距，2-4）；51.5%是单一物质暴露。在美国，无论是成人（>12岁）还是儿童（≤12岁），ECMO在中毒患者中的使用随着时间的推移都有显著增加（z=3.18，p=0.001），自2008年以来每年增加9-100%。使用量的增加更多地发生在成人患者。我们发现，通过地理空间映射与初始呼叫相关的ZIP，ECMO的使用有很大的地域差异，美国的大片地区，主要是农村地区没有报告病例。总体存活率为70%，在研究期间，儿童和成人的存活率没有明显差异。与其他中毒的患者相比，代谢和血液系统中毒的患者在体外膜氧合后存活的可能性更低（49%比72%；p=0.004）。

In total, 407 patients met final inclusion criteria (332 adults, 75 children). Median age was 27 years (interquartile range, 15–39 yr); 52.5% were male. Median number of ingested substances was three (interquartile range, 2–4); 51.5% were single-substance exposures. Extracorporeal membrane oxygenation use in poisoned patients in the United States has significantly increased over time (z = 3.18; p = 0.001) in both adults (age > 12 yr) and children (age ≤ 12 yr), increasing by 9–100% per year since 2008. Increase in use occurred more commonly in adults. We found substantial geographical variation in extracorporeal membrane oxygenation use by geospatially mapping the ZIP code associated with the initial call, with large, primarily rural areas of the United States reporting no cases. Overall survival was 70% and did not vary significantly over the study period for children or adults. Patients with metabolic and hematologic poisonings were less likely to survive following extracorporeal membrane oxygenation than those with other poisonings (49% vs 72%; p = 0.004).

研究结论

在美国，ECMO用于支持危重、中毒患者的使用率正在增高，主要是12岁以上患者的使用率增加。随着时间的推移，我们没有观察到存活率增高的趋势。当ECMO用于代谢或血液系统中毒时，死亡率更高。美国以农村为主的大片地区报告没有体外膜氧合中毒的病例。进一步的研究应集中在完善ECMO应用于中毒的标准。

The use of extracorporeal membrane oxygenation to support critically ill, poisoned patients in the United States is increasing, driven primarily by increased use in patients greater than 12 years old. We observed no trends in survival over time. Mortality was higher when extracorporeal membrane oxygenation was used for metabolic or hematologic poisonings. Large, predominantly rural regions of the United States reported no cases of extracorporeal membrane oxygenation for poisoning. Further research should focus on refining criteria for the use of extracorporeal membrane oxygenation in poisoning.

表1. 人口统计信息，包括中毒原因、医疗预后和整个队列的暴露途径，并按年龄分成两组